Tag Archives: PRP

A sitting injury in disguise

Six months ago I wrote in jubilation that I had finally overcome my 17-year long struggle with high-hamstring tendinopathy. What first emerged as a nagging high school running injury has since haunted me with its frustratingly sporadic flare-ups. It seemed to rear its ugly head at random, with no clear relation to any aspect of my training – not distance, speed or hills. It must be my form, I reasoned. Since rehabbing with PRP, I’ve devoted these past several months to optimizing my running mechanics to prevent another resurgence of the dreaded hamstring pain. And these efforts have been paying off, as I’ve felt stronger and more fluid in my running than perhaps ever before. I considered myself officially victorious over this decades-long injury.

That is, until one week ago … one week ago, on a rest day (i.e., no running) at the end of an easy, low-mileage recovery week. After some light morning yoga and a day spent sitting at lab, I began to feel an achy spasm and cramping in my hamstring – an all-too familiar sensation that literally appeared out of nowhere on my drive home. The pain escalated over the subsequent hours and I was soon in the throes of my worst hamstring flare-up in a year. Tension and pain radiated from my neck down through the back of my knee and I fantasized about a chiropractic adjustment of my misaligned back and pelvis. I struggled through each run this week, but rest was not an option. In fact, the greatest pain was at rest; sitting, and especially driving, were torturous and even sleeping was a challenge. A week later, I’m finally seeing some light at the end of the tunnel, thanks to some aggressive ART, Graston and dry needling. While encouraging, this does not answer what caused the flare-up in the first place. I had done nothing obvious to exacerbate it, and had even been cautiously respecting my recovery week.

04The answer, I’m now convinced, lay in a tiny skin irritation at the ischial tuberosity where the hamstring tendon attaches to the sit bones – the exact spot where I felt the most intense pain. The spot appeared coincidentally – or so I thought – around the same time the hamstring pain first set in. The “coincidence” didn’t faze me until a week later, and I finally began putting two and two together. The irritation was at the epicenter of my pain, which escalated to unbearable when sitting. Incidentally, there have been only two periods of my life when I’ve enjoyed extended relief from the injury: First, during a six-month trip around the world, during which my days were spent walking, hiking and exploring. Second, another six-month period while briefly working in a lab that required me to be on my feet at length. A clear pattern began to emerge. Freedom from desk-work and sitting correlated with symptom relief, whereas excessive sitting (with a sore on my tush as proof) correlated with spontaneous hamstring flare-ups.

Could my running injury have been a sitting injury all along? Perhaps this is wishful thinking. Perhaps there remains a running training error at the heart of the issue that I have yet to discover. But until then, I’m confidently adding hamstring trauma to the growing list of reasons sitting is hazardous to our health and a threat to the sanity of a running addict.

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PRP: A shot full of miracles

Four and a half weeks ago I couldn’t bend over, extend my leg in front of me or sit for more than a few minutes without a deep pain in the butt. Four and a half weeks ago I got my first injection of platelet-rich plasma (PRP) to treat a chronic hamstring tendinopathy. I was desperate and eager, but also very skeptical. “You’re a perfect candidate for the treatment,” my doctor encouraged me. “We’ve had incredible success with cases just like yours.” I wanted so badly to believe him, but didn’t want to face the disappointment if it didn’t work. This was my last resort. I had tried every other treatment in the books – ART, physical therapy, massage, dry needling, you name it – none of it helped. So why would PRP? What would I do if it didn’t work?

Platelet-rich plasma: The nitty-gritty

I covered the procedure in detail previously, but to summarize, I received three injections into the injured hamstring, each spaced a week apart. The first was intensely painful, but each subsequent shot was noticeably more tolerable. Despite my doctor’s advice to avoid running completely, I continued running throughout the treatment and recovery, albeit at a slightly reduced mileage (I’ve been logging roughly 25-35 miles/week, compared to my typical 40-45 miles/week). At no point did I feel the running set me back, and if anything, I suspect the gentle activity may have helped stimulate healing.

So, did it work, you ask?

Fast forward to today, and I can confidently say I’ve experienced a medical miracle. I’m by no means 100%, but in just a month I’ve witnessed dramatic, objective improvement and continue to improve daily. For the first couple of weeks, I really wanted to feel an effect and at points convinced myself I felt something. In retrospect, these early notions were most certainly a placebo effect. However, right around two weeks – after my final treatment  – the wishful thinking turned into an undeniable reality. Since then I’ve developed 1) increased range of motion, 2) remarkable strength, and 3) essentially no pain running. Even my ART and massage therapists were astounded at how different … healthier … my tissue felt. So I guess it’s really not just in my head?

Welcome back, Gumby!

I’ve always been flexible … almost too flexible for a runner. But that range of motion disappeared with my recent hamstring flare-up, and I haven’t been able to bend over without intense pain in seven months. Today, I can easily touch my toes (pain-free and without fear of ripping my hamstring!) and can almost do the splits, just like my typically Gumby-esque self.

Return of strength

The tearing in my hamstring left me not only tight and inflexible, but also weak. I’ve been unable to do simple exercises that engage the hamstring, like reverse planks and hamstring curls. Today, my bad leg is still weaker than my good, but I can hold a single-legged reverse plank without collapsing in pain. Now that‘s progress!

Goodbye pain!

The last tidbit of evidence that I’m legitimately improving is the joyous absence of pain while running! Sure, I still feel tight. My stride occasionally shortens, especially with fatigue or during the last couple miles of a long run. But I no longer have to stop mid-run to jam my fist into my cramping butt. Perhaps the most wondrous perk of the this miraculous healing process has been regaining those blissful miles of meditative escape. Instead of cringing in anxious anticipation of when my hamstring will throw a tantrum, or of when my hip will lock up and my feet will refuse to turn over, I can once again float along, physically fluid and mentally free.

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PRP. It’s a real pain in the butt

Seventeen years now. It’s been roughly 17 years that I’ve struggled with intermittent hip pain / hamstring tightness / sciatica, blah-ba-de-blah, etc. It comes and goes, and while it has never stopped me from running, it has stopped me from running well. My latest flare-up, which began about six months ago, has been the worst – and most stubborn – yet.

THE VERDICT

Having completely run out of patience babying my achy butt, moderating my speed and gingerly prancing up hills to avoid overstretching my immobile hamstring, I finally saw an orthopedist and pushed for an MRI. Verdict: chronic partial tearing, scarring and tissue thickening along the hamstring, most severe at its origin near the ischial tuberosity; essentially high-hamstring tendinopathy. It’s anyone’s guess when the degeneration began, but the tendon clearly isn’t healing itself. After an unwelcome lecture pointing out that my aging body is only going to further weaken (I’m 32 for god’s sake!), that my vegetarian diet is not suited for athletes (curious how he’d explain these ultra-runner and ultra-athlete veggie legends), that my bare feet need “support” and that I should really just stop running so much, my doctor finally offered a rational alternative: PRP, or Platelet Rich Plasma. I eagerly agreed, desperate to try anything that might nip this butt-pain in the bud and finally restore strength and functionality to my weakened tendon.

THE PROCEDURE

As a relatively new technique, PRP protocols vary considerably across practices. My doctor advised a series of three injections, spaced 7-10 days apart, although he reported the number of necessary treatments can range anywhere from one to five, depending on the injury and patient. And in some cases, the treatment isn’t effective at all. The procedure is actually quite simple and takes under an hour. They first draw blood which is then centrifuged and processed for several minutes to yield a solution rich in platelets. This provides a concentrated source of factors that support healing, like growth factors and cytokines. The goal is to induce an inflammatory response to promote tissue repair. Next, the doctor identifies the target site by manually probing around until he hits the “hot spot” of pain. After preparing the skin with some disinfectant (and a mysterious cooling liquid), he inserts the needle, guided by ultrasound, and injects the platelet-rich plasma. In my case, the pain was relatively diffuse, so he injected at several different locations of my hamstring origin, to cover all bases.

Platelet_Rich_Plasma_PRP-Therapy-IMAGE

I will not lie, the procedure isn’t fun. There were some painful moments, although never intolerable. I’ve read that many physicians will use local anesthetics during the procedure and prescribe pain-killers for pain management, although mine did neither. I guess I just look that tough. 😉

As a relatively novel, borderline experimental treatment, PRP isn’t covered by all insurance plans. Mine fortunately covered it fully. Otherwise, each injection may put you back $1000 or more.

THE AFTERMATH

The doctor indicated that I’d be fine to drive afterwards, which was far from true. For the next couple of days, sitting – especially on hard surfaces or while driving – was extremely uncomfortable. There was a constant deep, dull ache and the sensation of a severe bruise at the injection site. Since the therapy relies on a strong inflammatory response, ice and anti-inflammatory medications (which I avoid anyway) are not allowed. Each day the pain subsides slightly, and today, four days post-injection, I feel 90% normal (not healed, just 90% of my pre-PRP state).

ACTIVITY

My doctor gave very limited guidelines for my activity levels during the recovery period. He in fact skirted the issue, indicating that my activity depended on my “need” to run, and my healing goals. On one hand, he said, he’s had athletes compete hard just a few days after the treatment and manage a full, successful recovery. On the other hand, any amount of irritation to the tissue could delay healing and set me back. A confusing, unsatisfactory response. Being both a strong believer in active recovery, and one who spirals rapidly downwards when I can’t run, I opted for the more aggressive recovery trajectory.

After two days of near total rest (excepting some very light yoga), I ventured out on a test run. I set a mental limit of three miles, acknowledging that attempting a run so soon was pushing the envelope already. So of course, I accidentally ran six instead. To my great surprise, my hamstring felt no worse than pre-PRP. Sure, it was tight. Yes, it was achy. But the discomfort level was the same as while resting or walking, and did not progress throughout the run. Today – the day after this test run – the hamstring continues to improve. So I’m treating myself to another easy run, of no more than 4 miles. I promise.

MY BOTTOM’S BOTTOM LINE

So what’s the verdict on PRP? It’s far too early to tell. For one, it’s admittedly painful. And at only four days into the therapy, it’s far too early to tell whether it’s working. Purportedly, symptoms may start to improve anywhere between several days to months after treatment. But the underlying science is logical, and the immediate resulting deep ache confirms that an inflammatory response is indeed underway. This is enough to give me hope, and hope is enough to keep fueling my runs.

Have you gotten PRP or are you considering it? I’d love to hear your experiences and questions!

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